Reduced Caloric Nourishment Doesn't Reduce Ventilator Use

No improvement in survival or infections with less calories in the critically ill with feeding tubes

TUESDAY, Feb. 7 (HealthDay News) -- Providing lower amounts of nutritional support does not reduce ventilator-free days, risk of death at 60 days, or infectious complications for critically ill patients with acute lung injury compared to providing full caloric nourishment, according to a study published online Feb. 5 in the Journal of the American Medical Association.

Todd W. Rice, M.D., of the Vanderbilt University School of Medicine in Nashville, Tenn., and colleagues conducted a randomized, open-label, multicenter trial of 1,000 adults who were within 48 hours of developing acute lung injury requiring mechanical ventilation and whose physicians intended to start enteral nutrition. Participants were randomized to receive either trophic or full enteral feeding for the first six days. After six days, the care of all patients still on ventilators was managed according to the full feeding protocol.

The researchers found that baseline characteristics between the groups were similar. The full-feeding group received significantly more enteral calories for the first six days (1,300 versus 400 kcal/d). Initial trophic feeding did not increase the number of ventilator-free days (14.9 versus 15.0) or reduce 60-day mortality (23.2 versus 22.2 percent), compared with full feeding. No differences in infectious complications were observed between the groups. Despite receiving more prokinetic agents, the full-feeding group experienced more vomiting (2.2 versus 1.7 percent of patient feeding days), elevated gastric residual volumes (4.9 versus 2.2 percent of feeding days), and constipation (3.1 versus 2.1 percent of feeding days). Mean plasma glucose values and average hourly insulin administration were both higher in the full-feeding group than in the trophic-feeding group over the first six days.

"In patients with acute lung injury, compared with full enteral feeding, a strategy of initial trophic enteral feeding for up to six days did not improve ventilator-free days, 60-day mortality, or infectious complications but was associated with less gastrointestinal intolerance," the authors write.